What is going on with my ADHD/ODD difficult child?

My 8 year old son was diagnosed with ADHD/ODD two years ago. He takes Concerta which has for the most part worked really well for him.

This past week has been a nightmare with him. He walked up to his older brother the other day (he was not provoked in any way) and just started punching him in the head! The next day he went up to his younger brother and just pushed him over. I caught him with a knife in his room and he said he was going to kill his little brother. I took it from him and of course hid all the knives in the house. Today he told me he was going to find them while I sleep and get to his younger brother and I wouldn't be able to stop him. Later this evening they were fighting about something and difficult child choked him so hard that it made him vomit!!! husband thinks he just needs his medications adjusted but I am thinking this has nothing to do with having ADHD and there is something more serious going on. Borderline Personality Disorder (BPD) does run in my family and my gut just tells me that this isn't standard ADHD and ODD behavioral issues.

ETA: I also wanted to say that he will fly into a rage now over the smallest little things. He's super rude which is new for him. He NEVER needs to sleep. It takes him forever to wind down at night (and this is AFTER he has Melatonin) and he frequently wakes up in the middle of the night and then he still gets up early for the day. I am exhausted.

Can you tell us a little bit more about your son? Are you saying that he has never been violent before until now? If so, something could have happened. And he has not had any medication changes? That is very upsetting, dangerous behavior and right now I would make sure he is never alone with his brother, nor able to BE alone with him. But it would be more worrying if he did this before rather than if it suddenly happened...perhaps something perpetrated it.

We really need more information before we can help you. What is the family situation like? How was he as an infant? A toddler? Before this? Who diagnosed him? Has he ever had a neuropsychologist evaluation? How does he relate to his school peers? Can he handle transitions well? You may want to do a signature like I did below.

If your gut is telling you that this is bipolar disorder, you should follow your gut. Is your son seeing a psychiatrist or is his pediatrician rx'ing his medications?

Have you asked your son why he did these things? Did a feeling or a thought precede these aggressive acts?

The decreased need for sleep is cause for concern. How much melatonin is he taking? When my son is manic, he can stay up all night even after 6 mg of melatonin (double his usual dose) and his evening dose of Seroquel. It is exhausting.

As a baby, he was always SUPER cranky, always crying, always spitting up, etc. He had frequent ear infections and had tubes put in when he was a year old. We were told this would help him sleep through the night but he was still waking up even when he was close to 2 years old. He had a pretty significant speech delay so we started receiving services through Help Me Grow and then he was transitioned in our school district for preschool services when he was 3. At that time we did a very thorough evaluation. He cried the entire time and his results put him in the range of being severely developmentally delayed. I believe they said his IQ was around 65 so he definitely qualified for services. Our Pediatrician was also concerned about his head circumference. It was off the charts and had been that way since birth so he ordered an MRI to make sure nothing serious was going on. The MRI showed that he had benign extra-axial fluid, which is something that has also been diagnosed in our youngest son. I recently talked with our Pediatrician about it and he said that maybe term "benign" shouldn't be used anymore because of all the patients he has had with it, they have all had speech delays and went on to have issues with hyperactivity and ADHD.

I knew pretty early on that he was just a SUPER busy kid so the ADHD diagnosis was no surprise at all. We see an excellent behavioral Pediatrician who diagnosed him. We went through a couple of different medications at first but once he was put on Concerta it was like I had a completely different kid. He was able to focus in school and he was just easier to deal with. We also got the ODD diagnosis at the same time (this was in Feb. 2009 right around his 6th birthday) but it really had slipped my mind as being a part of the diagnosis because once we started the Concerta, ALL of his bad behaviors went away. They briefly resurfaced about a year ago and we upped his dosage and he has been on 36 mg ever since. Our pediatrician. said that is the highest he is willing to go for someone K's age and size.

K was starting to transition into Kindergarten when we got the diagnosis and it was beyond apparent that all of the testing needed to be redone because his speech was much more developed. Our school psychologist also knew the previous IQ score wasn't accurate and didn't want that sticking around in his charts as his actual score. This time he tested 116. He still qualified for speech therapy because while I can understand him perfectly, he mumbles quite a bit and talks VERY QUICKLY when talking to anyone else. He fell onto a nightstand when he was 3 and knocked out 4 of his top teeth so that has also effected his speech as well.

Academically, he does okay. He excels in math and science, reading not so much. His handwriting is awful. He doesn't care for school at all. I mean, he goes but he never seems to really get excited about anything that takes place there. His teacher says he always speaks in a monotone voice all of the time. He gets along well with other kids but he very rarely will go up to another child and ask to play with him or her. He started a new school in November (we did open enrollment so all the boys could be in the same school) and he can only tell me the names of a few of his classmates. There have never been any behavioral issues at school. One day we did forget to give him his medicine and the teacher thanked me a few days later for getting the prescription refilled so quickly. :grins: He is on a speech therapy break right now because the therapist said that we won't be seeing any improvement in his speech until his top teeth come in.

Our home life is total chaos because of our 10 year old difficult child. He has mild Autism and he is exhausting. This is our kid who constantly threatens to burn the house down, threatens to hurt people, HATES school, tells people EXACTLY what he thinks of them, etc. He can be a total sweetheart one minute and a monster the next. Sometimes I wonder if K is copying his behaviors but while A makes threats ALL OF THE TIME, I have never caught him with a knife or choking anyone. Wait, I have caught him with knives because he likes to take apart toys and electronics but only for that reason. And I know he has shoved and hit his brothers before, it just isn't as angry and violent as K's outbursts. A's generally happen when he doesn't get his way and is frustrated. K's just seem to happen for no reason sometimes. And all of this is very new behavior. He was more defiant when we got the ODD diagnosis but this is all the new- like within the past few weeks. And it just scares me. He is a really sweet kid. He is an AMAZING big brother to his baby sister. He's funny and I know he doesn't like to get so out of control.

I am trying to think of more things to tell about him. He is OBSESSED with video games and will totally RAGE if he gets them taken away. I am VERY STRICT with what he can play and I don't allow any violent games in our home. He plays stuff like Mario and Sonic. And like I said he wakes up a lot at night. He will get a snack...or two...or three. I have found food hidden under his bed like he is hoarding a little stash for himself. He eats both breakfast and lunch at school and will constantly be bringing home things that he didn't eat at those meals- an unopened muffin, snack cake, etc. Maybe that's normal, I don't know but my other kids just toss something if they aren't going to eat it.

ETA- I missed a few things that were asked. I did ask him why he choked his little brother and his reply was just that he was bothering him. I wasn't in the room to see it happen but it's a definitely possibility. easy child/difficult child knows how to push every.single.button with his older brothers. I did witness a few of the violent behaviors earlier in the week and I do know that those were completely unprovoked. He handles transitions with no problems at all. As for the melatonin dosage we do 5mg.

I'm actually thinking of possibly mild autism for THIS child too. It does tend to run in families and I thought of it (especially with the speech delay and monotone speech and unwillingness to initiate conversation with peers). The teachers/school wouldn't know this, nor would the speech therapist (been there/done that). Have you thought about a neuropsychologist evaluatioin? Privately done?

My son is on the spectrum. He seemed to start talking overnight at 4 1/2. But other problems surfaced as he got older and most were not behavioral. They were more differences in his thinking that cause him to be different from his peers, enough so that he is almost eighteen and nowhere near able to live on his own or do the things other kids his age do. His IQ has tested all over the place, from 75 to 115. He is OBSESSED with videogames too. It's common with Autism Spectrum Disorders (ASD)...a common obsession. I know most boys love videogames, but this is beyond just overfocusing on them. Maybe you know what I mean. My nickname here for my son is Sonic...lol (see below). He has been overeating since he was put on medication and is quite overweight, but he finds ways to sneak food. We just had him evaluated and were told this not knowing when he is full is also a part of autistic spectrum disorder. Not all kids with that have the overeating, but it's common. HOWEVER, autism does not necessarily go hand-in-hand with violence. Mental illness can be co-morbid with it. It often is. Sometimes, though, it is the frustration of not understanding t he world around him and feeling misunderstood...

Even if it's not this issue for your son, there are enough red flags going on that I'd take it to a neuropsychologist. I wouldn't trust any sort of behavioral or neurological issue to just a pediatrician, no matter how good he is. And you should make sure he has some medication since he is so much better on it...some drug companies help you out when you can't afford a drug. You can look into that and see.

Him being on the spectrum has crossed my mind before. There are times I am certain he is, and then there are times where I think I am crazy and he is nowhere near the spectrum.

I am not familiar with a neuropsychologist evaluation at all. In fact, I don't think I have even heard of it. How do I go about getting one? Is this something I should also check out for my difficult child that has a solid Autism Spectrum Disorders (ASD) diagnosis?

Keep in mind that it may not be any one hard-and-fast diagnosis. You can be "within normal range" and yet be almost on the edge of diagnosis - which puts you much closer to abnormal than to average, but you don't get the benefit of the diagnosis.

There may be multiple things going on. There may be strong tendencies toward certain problems, but not enough to do a diagnosis.

neuropsychologist or equiv is best bet to start figuring out the issues, but don't settle for just one diagnosis unless its really clear THAT diagnosis covers all the bases.

Before Sonic was diagnosed, I would sometimes think I was crazy to think of the spectrum. Sometimes he was bright-eyed and responsive and smiling and animated. Sometimes though he'd fall into his own world and not even respond to our voices, especially if he was playing videogames. Now for all mothers who are thinking "Oh, all boys are like that with videogames" all I can say is I assure you NO THEY ARE NOT! This is something way different...lol. All three of my boys like games. My oldest boy was also a game fanatic, but he could pull away when he had to and he did not talk nonstop about Sonic and Mario when he wasn't playing videogames. He could also withdraw from game playing for other interests. My Autism Spectrum Disorders (ASD) son on the other hand not only would play forever if we allowed it, he has memorized every game title, the year it came out, and the "age" of every character. It is all written down neatly in a notebook and it's fascinating to see. He is the same way with his favorite television shows so we have to make sure he has outside activities and force him to participate (he likes them once he's there). However, it's no picnic to get him there. I often bribe him by saying we can do something afterward, like renting a movie.

Back to the "he seems autistic, he doesn't seem autistic" that was a real puzzle to us. However, when my son is with new people he doesn't know, he really retreats into himself and we can clearly see the spectrum issues. He sits in the back of the room, he won't look up, he won't join in, he only talks to people who talk to him and does it without eye contact and in "yes" and "no" or short phrased answers. He is comfortable at home and at the school he has gone to all his life so he is far more animated there. But, again, it is NOT just shyness. It is way beyond that. It's hard to explain if you haven't seen it :/

I wish you luck on your diagnostic journey. The neuropsychologist gave him three tests that target Autism Spectrum Disorders (ASD) and talked to him and observed him and tested him in almost every way possible for almost every disorder that exists and we got a ten page report. It was an all day 8-3 test and he sort of enjoyed it. He interacts better 1-1 than in a crowd and the neuropsychologist was very good at making him feel at home. The testing was well worth it to get him the services he will need when he graduates high school...we want him to have a fun, productive life even if he can't be 100% independent.